<!DOCTYPE html>
<html>
<head>
    <meta http-equiv="Content-Type" content="text/html;charset=utf-8"/>
    <meta name="viewport" content="initial-scale=1.0, user-scalable=no">

    <link href="//cdn.bootcss.com/bootstrap/3.3.5/css/bootstrap.min.css" rel="stylesheet">
    <script src="//cdn.bootcss.com/jquery/2.1.4/jquery.min.js"></script>
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    <script src="/javascripts/lib/jquery.cookie.min.js"></script>
    <script src="/javascripts/common.js"></script>
    <script type="text/javascript" src="/javascripts/companyController.js"></script>

    <title>尚悦丨与尚悦合作</title>
</head>
<body>
    <div class="panel panel-warning">
        <div class="panel-heading" style="text-align: center;font-size:1.5em;font-weight:700;">信息填写</div>
        <div class="panel-body">
            <div class="input-group">
                <span class="input-group-addon" id="basic-addon1">姓名</span>
                <input id="username1" type=text class="form-control" placeholder="姓名" aria-describedby="basic-addon1"></input>
            </div>
            <div class="input-group">
                <span class="input-group-addon" id="basic-addon2">联系方式</span>
                <input id="contact1" type="text" class="form-control" placeholder="联系方式" aria-describedby="basic-addon2"></input>
            </div>
            <div class="input-group">
                <span class="input-group-addon" id="basic-addon3">联系地址</span>
                <input id="address1" type="text" class="form-control" placeholder="需要寄送邮件" aria-describedby="basic-addon3"></input>
            </div>
            <div class="input-group">
                <span class="input-group-addon" id="basic-addon4">车型</span>
                <input id="cartype1" type="text" class="form-control" placeholder="车型" aria-describedby="basic-addon4"></input>
            </div>
            <div class="input-group">
                <span class="input-group-addon" id="basic-addon5">车号</span>
                <input id="carnumber1" type="text" class="form-control" placeholder="车号" aria-describedby="basic-addon5"></input>
            </div>
            <div class="input-group">
                <span class="input-group-addon" id="basic-addon6">车驾号</span>
                <input id="drivercarnumber1" type="text" class="form-control" placeholder="车驾号" aria-describedby="basic-addon6"></input>
            </div>
            <div class="input-group">
                <span class="input-group-addon" id="basic-addon7">身份证号</span>
                <input id="idcard1" type="text" class="form-control" placeholder="身份证号" aria-describedby="basic-addon7"></input>
            </div>
            <div class="input-group">
                <span class="input-group-addon" id="basic-addon4">保险单号</span>
                <input id="policyno1" type="text" class="form-control" placeholder="保险单号" aria-describedby="basic-addon4"></input>
            </div>
            <div class="input-group">
                <span class="input-group-addon" id="basic-addon5">点击上传</span>
                <input id="idphoto1" type="file" class="form-control" placeholder="合作方身份证件" aria-describedby></input>
            </div>
            <div class="input-group">
                <span class="input-group-addon" id="basic-addon5">扫描件上传</span>
                <input id="scanningcopy1" type="file" class="form-control" placeholder="" aria-describedby></input>
            </div>
            <hr>
            再来一辆
                        <div class="input-group">
                <span class="input-group-addon" id="basic-addon1">姓名</span>
                <input id="username2" type=text class="form-control" placeholder="姓名" aria-describedby="basic-addon1"></input>
            </div>
            <div class="input-group">
                <span class="input-group-addon" id="basic-addon2">联系方式</span>
                <input id="contact2" type="text" class="form-control" placeholder="联系方式" aria-describedby="basic-addon2"></input>
            </div>
            <div class="input-group">
                <span class="input-group-addon" id="basic-addon3">联系地址</span>
                <input id="address2" type="text" class="form-control" placeholder="需要寄送邮件" aria-describedby="basic-addon3"></input>
            </div>
            <div class="input-group">
                <span class="input-group-addon" id="basic-addon4">车型</span>
                <input id="cartype2" type="text" class="form-control" placeholder="车型" aria-describedby="basic-addon4"></input>
            </div>
            <div class="input-group">
                <span class="input-group-addon" id="basic-addon5">车号</span>
                <input id="carnumber2" type="text" class="form-control" placeholder="车号" aria-describedby="basic-addon5"></input>
            </div>
            <div class="input-group">
                <span class="input-group-addon" id="basic-addon6">车驾号</span>
                <input id="drivercarnumber2" type="text" class="form-control" placeholder="车驾号" aria-describedby="basic-addon6"></input>
            </div>
            <div class="input-group">
                <span class="input-group-addon" id="basic-addon7">身份证号</span>
                <input id="idcard2" type="text" class="form-control" placeholder="身份证号" aria-describedby="basic-addon7"></input>
            </div>
            <div class="input-group">
                <span class="input-group-addon" id="basic-addon4">保险单号</span>
                <input id="policyno2" type="text" class="form-control" placeholder="保险单号" aria-describedby="basic-addon4"></input>
            </div>
            <div class="input-group">
                <span class="input-group-addon" id="basic-addon5">点击上传</span>
                <input id="idphoto2" type="file" class="form-control" placeholder="合作方身份证件" aria-describedby></input>
            </div>
            <div class="input-group">
                <span class="input-group-addon" id="basic-addon5">扫描件上传</span>
                <input id="scanningcopy2" type="file" class="form-control" placeholder="" aria-describedby></input>
            </div>
            <div  style="margin-top: 10px;">
                <button type="button" class="btn btn-warning btn-sm sure-apply">我确定以上信息无误</button>
                <button type="button"class="btn btn-warning btn-sm cancle-apply">取消</button>
                <p>
                    备注:正在进行人工审核，审核过程在两个工作日完成，届时将会有工作人员与之联系，请保持联络畅通
                </p>
            </div>
        </div>
    </div>
</body>
</html>